自牵引后离断联合双重抗反流技术在全腹腔镜近端胃切除双通道消化道重建中的应用价值

Application value of self-pulling and latter transection combined with dual anti-reflux technique in dual-tract reconstruction of total laparoscopic proximal gastrectomy

随着我国胃癌流行病学的变化,食管胃结合部腺癌及其早期癌的诊断与治疗率逐年提高,手术方式也随之发生变化并已成为外科领域研究的重点。全胃切除是食管胃结合部腺癌的主要治疗方式,近年来保功能理念逐渐被学术界重视并开展系列近端胃切除、保留远端胃的消化道重建手术方式探索,其主要研究指标是抗反流疗效和对营养预后的影响,间置空肠和双通道重建疗效确切,但其操作复杂,成为全腹腔镜手术的难点。降低反流性食管炎发生率和改善营养状况也是目前研究的热点。笔者回溯国内外相关研究成果,结合笔者医学中心经验,对全腹腔镜近端胃切除自牵引后离断食管-空肠吻合与双重抗反流双通道残胃-空肠吻合重建方式进行深入分析和阐述。

Along with the changes in the epidemiology of gastric cancer in China,the early diagnosis and treatment rate of adenocarcinoma of esophagogastric junction has elevated significantly,while its surgical methods have also altered and become a hotspot.Total gastrectomy has become the primary surgical allocation for adenocarcinoma of esophagogastric junction.In recent years,a series of studies on proximal gastrectomy and digestive reconstruction after distal stomach preserving have been explored due to recent concept of functional preservation.The main concern about this surgical method is the efficacy of anti-reflux and its influence on nutritional prognosis.Interpositioned jejunum and double tract reconstruction have curative effects.However,they become obstacles for total laparoscopic surgery due to the complexity of surgical operation.Thus there is increasing concern to explor the way to reduce the reflux rate and improve the nutritional status of patients.Baesd on related research at home and abroad,combined with their own experiences,the authors comprehensively analyze and illustrate self-palling and latter transection with esophagojejunostomy and double anti-reflux double tract reconstruction of total laparoscopic proximal gastrectomy.